Efficiency of Emergency Physicians: Insights from an Observational Study using EHR Log Files

Abstract

Objective: With federal mandates and incentives since the turn of this decade, electronic health records (EHR) have been widely adopted and used for clinical care. Over the last several years, we have seen both positive and negative perspectives on its use. Using an analysis of log files of EHR use, we investigated the nature of EHR use and their effect on an emergency department's (ED) throughput and efficiency.

Methods: EHR logs of time spent by attending physicians on EHR-based activities over a 6-week period (n = 2,304 patients) were collected. For each patient encounter, physician activities in the EHR were categorized into four activities: documentation, review, orders, and navigation. Four ED-based performance metrics were also captured: door-to-provider time, door-to-doctor time, door-to-disposition time, and length of stay (LOS). Association between the four EHR-based activities and corresponding ED performance metrics were evaluated.

Results: We found positive correlations between physician review of patient charts, and door-to-disposition time (r = 0.43, p < 0.05), and with LOS (r = 0.48, p < 0.05). There were no statistically significant associations between any of the other performance metrics and EHR activities.

Conclusion: The results highlight that longer time spent on reviewing information on the EHR is potentially associated with decreased ED throughput efficiency. Balancing these competing goals is often a challenge of physicians, and its implications for patient safety is discussed.

Fig. 1

Patient trajectory from arrival to the emergency department (ED) to discharge. The four ED performance metrics: door-to-provider, door-to-doctor, door-to-disposition, and length of stay are shown with respect to a patient's care trajectory through the ED. On the lower half, the time spent on each of the four electronic health record (EHR)-based activities during each of the performance metric measurement phases is shown: documentation (D), review (R), orders (O), and navigation (N). The time spent measures are not drawn to scale.